who are being treated. If the condition Introduction of "new" drugs is adequately controlled the patient will be reassured to find his blood pressure To the editor: Dr. G.S.L. Wilson's letis normal. If it is inadequately con- ter regarding the introduction of new trolled the patient should be advised drugs (Can Med Assoc J 112: 555, to see his family physician for further 1975) requires that the record be set straight. There is no substance to allescrutiny. gations that the health protection I. FEFERMAN, MD branch (HPB) of Health and Welfare Mount Sinai Hospital Canada delays unnecessarily the in-. Toronto, Ont. troduction of new useful drugs or insists on Canadian evidence if satisfacDrugs in pregnancy tory evidence of efficacy and safety To the editor: In his paper "A clinical obtained elsewhere can be submitted. look at the problem of drugs in preg- Dr. Wilson brings forth no evidence nancy and their effect on the fetus" to substantiate his claims other than a (Can Med Assoc J 112: 728, 1975) vague reference to "company represenDr. Yaffe discusses the depressing ef- tatives". fect upon the neonate of meperidine In fact, a comparison of the number given to the mother within 2 to 3 hours of new single-ingredient drugs in nine of birth. He states that the duration main therapeutic categories, marketed of these effects and their ultimate con- for the first time in Canada or in the sequence for the child are not clear at United States from 1962 to 1971, represent. veals that there is a clear advantage for A prospective study of perinatal Canada in terms of the early availabilcauses of brain damage, which we re- ity of new drugs in essential therapeutic ported in 1969,1 supplies some reas- areas. Approximately 78% of 121 new surance. One of the groups of children drugs in these categories were marketed had been exposed to what we defined in both countries without any noticeas an excess of obstetric anesthesia or able advantage of earlier availability. analgesia. Of the 104 children in this However, of the remaining 22% (27 group 70 (67%) were born to mothers drugs) that were marketed in only one who had received meperidine within of the two countries, more than 90% 2 hours of birth. At birth 19% had an (24 drugs) were marketed exclusively in Apgar score of less than 9, compared Canada. with 7% of the controls. However, an In addition, analysis of the status in intensive psychologic and physical ex- Canada of 24 drugs that might repreamination of this group of children at sent important therapeutic advances, the age of 5 years showed them to be out of a list of nearly 200 prescription in no way inferior to the control group. drugs presently unavailable in the An assessment of their academic pro- United States, fails to support the congres. and behaviour during their 3rd tention that the HPB delays the introor 4th year in school upheld the earlier duction of valuable new drugs. Out of result. (All comparisons with controls these 24 drugs 5 are permitted for full incorporated adjustments for socioeco- marketing, 4 have been cleared for nomic variables.) clinical trials, 5 are in the review proSince our study was concerned with cess, 1 was withdrawn by the manufacthe effects of single perinatal complica- turer and for 9 no request for markettions, all the children were of mature ing has been received. These data show birth weight and without other com- that in a large number of instances, plications of pregnancy or labour. absence of a drug from the Canadian Whether long-term harmful effects of market results from a decision on the meperidine occur in children exposed part of manufacturers not to market to other perinatal insults cannot be their product in this country. answered from our data. With respect to the allegation that the HPB insists on new, preferably CAROL BUCK, MD, PH D, DPH Department of epidemiology Canadian evidence, it has always been and preventive medicine Faculty of medicine our policy to accept drug data obtained University of Western Ontario elsewhere so long as the studies are London, Ont. reported with the details necessary for References scientific evaluation and support the 1. BUCK C, GREGG R, STAYRAKY K, et al: The efficacy and safety of the product in effect of single prenatal and natal complications upon the development of children of question. This fact could readily have mature birthweight. Pediatrics 43: 942, 1969 been verified by Dr. Wilson had he chosen to do so. Table I-Hypertensive values (in mm Hg) according to age The responsibility for making availAge (yr) able new chemicals resulting from their research and maintaining adequate supUnder 40 40-64 65 and over plies of essential drug products rests Systolic > 155 . 160 > 165 primarily with the drug industry. This Diastolic > 95 > 95 > 100 should be borne in mind when conScreening for hypertension To the editor: Prompted by the article "Use of shopping centres in screening for hypertension" by Silverberg and colleagues (Can Med Assoc J 111: 769, 1974), we have begun to screen for hypertension in the emergency department of our hospital. A specific protocol has been set up for the nurses to follow. Every patient who comes to the emergency department has his or her blood pressure taken and recorded. If the pressure is found to be elevated according to the criteria of Silverberg et al (Table I), the procedure is repeated before the patient leaves. If both readings are high the nurse advises the patient that his blood pressure has been found to be elevated. It is stressed that this does not mean that he is hypertensive, but he is encouraged to see his family physician for further blood pressure readings and investigations if necessary. If the initial blood pressure is elevated and the repeat is normal, the patient is considered normotensive. In order to obtain a small patient sample a 1st-year medical student took the blood pressures of 100 patients. Four patients who had no history of hypertension were found to be hypertensive. Ten patients who were previously hypertensive and were currently taking medication were found to be normotensive. The condition of nine patients, however, who knew they were hypertensive was inadequately controlled. Since an increasing number of patients are being seen in emergency departments we believe that the opportunity should be used to screen for hypertension. If the department is very busy it is not to be considered a matter of top priority to measure the blood pressure of a patient with a sore thumb when other people are waiting. However, in most emergency departments a nurse "admits" the patient to an examining room where he waits to be seen by the physician. As part of the admitting procedure the nurse should take the patient's blood pressure. If it is elevated, either the nurse or the physician should check it before the patient leaves and advise him according to the findings. Screening in the emergency department serves two purposes. It provides an opportunity to discover new cases of hypertension and to check patients

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